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This paper examines the paper of Haux et al. in this issue of this journal. It gives some background on specifics of the German health care system, which underlie the theses and prognoses proposed by Haux et al. In analogy to a forecast of the future of health informatics, which is now 10 years old, I then suggest that these attempts meet two types of challenges:•that of overestimating the positive effects of recent advances, which later are found not to scale up; and•that of blind spots with respect to unforeseen significant advances.The attempt to find indications of such in the projections of Haux et al. leads, among other, to the conclusion that the projections of direct linkages between patients and care providers may be overoptimistic. As to wheather the deviating opinions matter in the end, it is concluded that the technology advances may require less attention that the restructuring of the health care system required to take advantage of the advances of technology. [Copyright &y& Elsevier]

The implementation of the European Water Framework Directive requires reliable tools to predict the water quality situations in streams caused by planned land use changes at the scale of large regional river basins. This paper presents the results of modelling the in-stream nitrogen load and concentration within the macro-scale basin of the Saale river (24,167km2) using a semi-distributed process-based ecohydrological dynamic model SWIM (Soil and Water Integrated Model). The simulated load and concentration at the last gauge of the basin show that SWIM is capable to provide a satisfactory result for a large basin. The uncertainty analysis indicates the importance of realistic input data for agricultural management, and that the calibration of parameters can compensate the uncertainty in the input data to a certain extent. A hypothesis about the distributed nutrient retention parameters for macro-scale basins was tested aimed in improvement of the simulation results at the intermediate gauges and the outlet. To verify the hypothesis, the retention parameters were firstly proved to have a reasonable representation of the denitrification conditions in six meso-scale catchments. The area of the Saale region was classified depending on denitrification conditions in soil and groundwater into three classes (poor, neutral and good), and the distributed parameters were applied. However, the hypothesis about the usefulness of distributed retention parameters for macro-scale basins was not confirmed. Since the agricultural management is different in the sub-regions of the Saale basin, land use change scenarios were evaluated for two meso-scale subbasins of the Saale. The scenario results show that the optimal agricultural land use and management are essential for the reduction in nutrient load and improvement of water quality to meet the objectives of the European Water Framework Directive and in view of the regional development plans for future. [Copyright &y& Elsevier]